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Organization
EAST SIDE INTEGRATIVE MEDICINE PC
Active
Organization
EAST SIDE INTEGRATIVE MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN JAMES MEDRANO (DIRECTOR)
(720) 251-9215
Entity
Organization
Contact information
Practice address
1 BARKER AVE STE 200, WHITE PLAINS, NY 10601-1523
(845) 422-6504
Mailing address
1 BARKER AVE STE 200, WHITE PLAINS, NY 10601-1523
(845) 422-6504
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
NULL
261QM1300X
Multi-Specialty Clinic/Center
—
NULL
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
284877
PSYCHIATRIST
NY
Enumeration date
12/02/2022
Last updated
02/24/2026
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